Provider Demographics
NPI:1700188182
Name:COPELAND, MICHELLE MARIE (AUD)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:MARIE
Last Name:COPELAND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LERCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1330 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050
Mailing Address - Country:US
Mailing Address - Phone:740-393-9000
Mailing Address - Fax:740-392-0167
Practice Address - Street 1:1451 YAUGER RD STE 1B
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-7906
Practice Address - Country:US
Practice Address - Phone:740-397-0700
Practice Address - Fax:740-392-4620
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01756231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist